Provider Demographics
NPI:1073079588
Name:BURD PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:BURD PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURDICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:585-300-4333
Mailing Address - Street 1:3070 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4604
Mailing Address - Country:US
Mailing Address - Phone:585-300-4333
Mailing Address - Fax:585-445-7327
Practice Address - Street 1:3070 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4604
Practice Address - Country:US
Practice Address - Phone:585-300-4333
Practice Address - Fax:585-445-7327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06134138Medicaid